Dd. Stevenson et al., ASPIRIN DESENSITIZATION-TREATMENT OF ASPIRIN-SENSITIVE PATIENTS WITH RHINOSINUSITIS-ASTHMA - LONG-TERM OUTCOMES, Journal of allergy and clinical immunology, 98(4), 1996, pp. 751-758
Background: Aspirin-sensitive patients with asthma experience continuo
us inflammation of their nasal and sinus tissues, complicated by recur
rent sinusitis, which frequently leads to asthma attacks. Systemic cor
ticosteroid therapy and sinus or polyp surgery are currently required
to central underlying rhinosinusitis, and bursts of corticosteroids ar
e used for asthma control. Objective: After aspirin desensitization th
erapy, objective measures of respiratory disease activity, linked to t
he need for systemic corticosteroids and sinus surgery, were studied t
o determine whether any changes occurred. Methods: Sixty-five aspirin-
sensitive patients with asthma underwent aspirin challenge, followed b
y aspirin desensitization and daily treatment with aspirin over 1 to 6
years (mean, 3.1 years). Clinical outcome measurements before aspirin
desensitization treatment and during follow-up were analyzed for the
larger group of 65 patients and subgroups (29 patients receiving thera
py for 1 to 3 years and 36 patients receiving therapy for 3 to 6 years
). Results: In the larger group of 65 patients, there were significant
reductions in numbers of sinus infections per year (median, 6 to 2),
hospitalizations for treatment of asthma per year (median, 0.2 to 0),
improvement in olfaction (median, 0 to 2), and reduction in use of sys
temic corticosteroids (mean, 10.2 to 2.5 mg) with p values less than 0
.0001. Numbers of sinus and polyp operations per year were significant
ly reduced (median, 0.2 to 0; p = 0.004), and doses of nasal corticost
eroids (in micrograms) were significantly reduced (mean dose, 139 to 1
06 mu g, p = 0.01). Emergency department visits and use of inhaled cor
ticosteroids were unchanged. Conclusions: The results support a role f
or aspirin desensitization treatment of aspirin-sensitive patients wit
h rhinosinusitis-asthma.